Mental health programs face big cuts

After spending months resisting the additional federally funded Medicaid health care coverage provided by Obamacare, Michigan lawmakers finally approved the expansion last August, but they refused to let the initiative begin until April 1.

The plan called for a tradeoff: steep, steady cuts in state funding to local mental health agencies as the expanded Medicaid program gradually brought in new federal revenues.

In reality, mental health programs across the state are now feeling the cuts before those in need of mental health care are signed up for the broadened Medicaid program, known as Healthy Michigan.

State funding is still desperately needed, officials warn, for those who are not covered by Healthy Michigan or private insurance plans.

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The signup period for the new Medicaid – now available to people living at 133 percent of the poverty level – began a month ago but the amount of per-person funding that will flow from Washington to Michigan during this transition remains highly uncertain.

The Affordable Care Act’s wider reach was hailed by mental health professionals last year as a game-changer in treating those suffering from mental health problems, including the homeless, the developmentally disabled, psychiatric inpatients at hospitals, juvenile crime offenders, and those in need of crisis intervention.

But the two financial timetables do not mesh and it appears the resulting money gap could create a substantial hole in the safety net that provides community-based assistance.

In Macomb County, 1,350 people who do not have Medicaid coverage have been informed that they are no longer eligible for services. The county mental health director, John Kinch, warns that the change may mean more people who are seriously mentally ill or emotionally disturbed going to expensive hospital emergency rooms when confronted with a mental health crisis. Or, worse yet, some with violent tendencies may act out.

“I’m not an alarmist, but we’ve done everything we can … You have a large contingent of consumers who should be afforded a health care benefit who are not being offered a benefit.”

“I worry about tragedy. I don’t want it to appear here and be on (The Macomb Daily) front page. It absolutely is a real possibility.”

The Legislature last year set monthly payments to the state’s 46 community mental health agencies at $23.5 million. But the post-April 1 allocation was chopped to $13.9 million and the expenditure will eventually fall to $4.3 million monthly by the end of the fiscal year on Sept. 30.

As the Legislature moves toward completing the fiscal year 2015 budget two months early, on July 1, it appears that the mental health funding shortage is barely on Lansing’s radar.

In fact, House Speaker Jase Bolger sees no need to take up the matter because he believes a $25 million supplemental funding bill recently passed by the Legislature should sufficiently plug the hole created by the transition.

“The funds from Senate Bill 608 should be sufficient to maintain services at previous levels,” said Bolger’s spokesman, Ari Adler. “The Department (of Community Health) has indicated it will be tracking data on services and expenditures on a monthly basis following the April 1 start date and has accelerated General Fund payments to (community mental health) agencies to ease the transition into the Healthy Michigan plan.

“At this time, we have no plans to address any additional short-term funding for community mental health.”

Mental health officials paint an entirely different picture, warning that the slow start suggests it could take a year or more to get most of their clientele signed up for Healthy Michigan. In addition, many of those in the “difficult population,” such as the homeless, the schizophrenic and the paranoid, are difficult to reach.

In Macomb, that population lives mostly in the south end of the county. An estimated 72,000 people in Macomb County are eligible for the expanded Medicaid program and the goal is to enroll 40,000. So far, only 9,000 have signed up for the Healthy Michigan program.

For the coming fiscal year, “we are still at least $60 million, and as much as $100 million, short in funding statewide,” said Michael Vinzena, director of the Michigan Association of Community Mental Health Boards.

Kinch said his department is already struggling to deal with the loss of state funding that began on April 1.

“I’m already running a $3 million deficit over the next five months,” he said, “I don’t know where that money is going to come from.”